MEDICARE: OB-GYN ASSOCIATES, PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician

General Provider Information

NPI Number	:	1144396581
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OB-GYN ASSOCIATES, PA

Provider Business Mailing Address
First Line	:	699 CHURCH ST NE
Second Line	:	SUITE 300
City	:	MARIETTA
State	:	GA
Zip	:	30060-1110
Country	:	US
Telephone Number	:	770-422-8700
Fax Number	:	770-425-7601

Provider Business Practice Location Address
First Line	:	100 STONEFOREST DR
Second Line	:	SUITE 310
City	:	WOODSTOCK
State	:	GA
Zip	:	30189-4880
Country	:	US
Telephone Number	:	678-445-3555
Fax Number	:	678-445-7358

Authorized Official
Title or Position	:	PRESIDENT
Name	:	GOODMAN B ESPY III
Credential	:	M.D.
Telephone Number	:	770-422-8700

Provider Enumeration Date	:	11/28/2006
Last Update Date	:	10/21/2011

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